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Drugs that May Interact with CBD Oil

CBD oil interacts with certain prescription medications, which is why you should always consult your doctor before using cannabidiol.

CBD Oil Drug Interactions – The CYP450 Pathway

Research has begun to demonstrate that cannabidiol (CBD) has the potential to effectively help a large number of people. CBD oil interacts with the endocannabinoid system in a way that produces very few unintended side-effects.

While the majority of the vast majority of the science indicates CBD oil is safe for use and consumption, it does pose a few risks that, if not properly understood, could be dangerous.

One of these risks is the inhibition of the cytochrome P450 enzyme system.

What is the Cytochrome P-450 System?

Found within the liver, the cytochrome P450 enzyme system is responsible for metabolizing potentially toxic compounds, including over 60% percent of any drugs you have consumed.

According to Davis’s Drug Guide, this system contains more than 50 enzymes that process and eliminate toxins.

Why Does CYP450 Matter?

In order to determine the appropriate dosages of medications, doctors make calculations using the average amount of time it takes for various drugs and medications to be processed through the cytochrome P450 system.

If only one drug is being processed, and the system is generally healthy, these averages provide accurate dosage information.

However, certain substances have the ability to affect processing times within this system, making drugs metabolize faster or slower than they would on their own.

Similarly, if the cytochrome P450 system is unhealthy due to problems with the liver or other pre-existing conditions, drugs may not metabolize as they should.

Cannabidiol in the Cytochrome P-450 System

Cannabidiol can inhibit the cytochrome P450 system’s ability to metabolize certain drugs, leading to an overall increase in processing times.

Interestingly, CBD oil is not alone in its effect on drug metabolism. Grapefruit, watercress, St. John’s Wort, and goldenseal all have a similar impact in terms of CYP450 inhibition.

When the CYP450 system is impacted in this way, it leads to higher levels of certain drugs in your system at one time. This can cause unwanted side effects, and sometimes, an overdose.

If you are taking a medication affected by cannabidiol, you should consult your doctor to make sure that it is safe for you to supplement your personal care routine with CBD oil. From there, the two of you may consider adjusting the dosage on your medications so that you can use both products safely.

Drugs that Interact with Cannabidiol

Any drug metabolized by CYP450 enzymes could potentially interact with cannabidiol. According to the Indiana University Department of Medicine, drugs known to use the CYP450 system include:

  • Steroids
  • HMG CoA reductase inhibitors
  • Calcium channel blockers
  • Antihistamines
  • Prokinetics
  • HIV antivirals
  • Immune modulators
  • Benzodiazepines
  • Antiarrhythmics
  • Antibiotics
  • Anesthetics
  • Antipsychotics
  • Antidepressants
  • Anti-epileptics
  • Beta blockers
  • PPIs
  • NSAIDs
  • Angiotensin II blockers
  • Oral hypoglycemic agents
  • Sulfonylureas

This list does not include all of the potential medications impacted by cannabidiol. Nor will every medication in the categories contained on this list will cause an interaction. For these reasons, you should consult with a medical professional before supplementing with CBD oil.

There are certain medications, known as “prodrugs,” that need to be metabolized to produce the therapeutic compound. In other words, you ingest an inactive compound and once in the body, it is processed into the active drug. If this processing is dependent on CYP3A4 (part of the larger CYP450 system), then inhibitors can result in too little active drug in the body for the desired therapeutic effect.

Codeine, for example, is a prodrug that is metabolized into morphine which provides the effect.

Vyvanse and Concerta are two other popular pharmaceutical medications for ADHD that fall into this category.

If you are worried that your CYP450 pathway may not be functioning properly, physicians can test the system to ensure that the medications you take are metabolizing as expected.

Drugs that Interact with CBD Oil

Combining Alcohol and CBD Oil

Alcohol and cannabis are both widely consumed in our society and the effects of combining the two are well known.

What is less understood by the general public, is the effects of combining alcohol and the cannabinoid compound CBD.

Alcohol depends on a few different metabolic pathways in the human body, with the primary enzymes involved being:

In people who only drink socially or occasionally, ADH and ALDH handle the entire workload of metabolizing ethanol. However, when binge drinking (or during chronic consumption of alcohol) CYP450 gets involved to assist the overloaded ADH and ALDH pathways.

Here are some interesting tidbits about alcohol and CBD oil:

  • The CB1 receptor is a significant player in the reinforcing and motivating attributes of alcohol. [S]
  • Combining alcohol and CBD results in significantly lower blood levels of alcohol. [S]
  • CBD reduces the reinforcement, motivation and relapse for alcohol. [S]
  • CBD protects the liver from damage done by binge-drinking alcohol. [S]
  • CBD prevents against alcohol-induced neurodegeneration. [S]
  • CBD attenuates alcohol-induced liver steatosis, metabolic dysregulation, inflammation and neutrophil-mediated injury. [S]
  • Cannabinoids have an effect on nearly all enzymes responsible for metabolizing alcohol. [S]
  • CB1 receptor agonists (THC) encourage alcohol consumption, while CB1 receptor antagonists (CBD) decrease it. [S]

Although the pharmacokinetics of alcohol and CBD are not yet well-understood, what we do know is CBD inhibits the CYP450 enzyme system, and this system plays a significant role in alcohol metabolism.

Additionally, as found in mice, CBD alters levels of ADH and ALDH to varying degrees.

It is important to be mindful and cautious when mixing CBD and alcohol.

Caffeine and CBD – Better than a PB&J

Caffeine is the world’s most famous and commonly consumed psychoactive drug. Who doesn’t ingest even a little from time to time?

CBD oil is rapidly gaining ground on coffee in terms of popularity and so it only makes sense that people would start combining the two.

As it turns out, the two substances go very well together!

Caffeine is molecularly very similar to adenosine, a compound produced in our bodies that activates the A2a receptor. Caffeine binds to the A2a receptors, inhibiting the reuptake of adenosine.

When adenosine binds to the A2a receptor, the result is what is commonly known as the ‘rest and digest’ effect. It helps us to calm down and relax. Because caffeine inhibits adenosine from binding to its receptors, it increases clarity and alertness.[S]

Similarly, CBD oil also binds to the A2a receptor, blocking the reuptake of adenosine.[S] So the theory goes that by combining caffeine and CBD, adenosine is blocked across the board, resulting in not only more stimulation, but reduced anxiety (due to CBD’s effects on other neurotransmitters systems).

It is worth noting that these effects depend on the serving size of the CBD. High amounts of CBD are more likely to cause drowsiness and sedation.

Additionally, caffeine is metabolized by a CYP450 enzyme, specifically CYP1A2. As CBD inhibits the CYP450 enzyme system, a slowed excretion rate of caffeine will occur. This can mean the effects of the caffeine will be more prolonged and drawn out. The can be both good and bad!

On the bright side, CBD oil and caffeine together will cause the boost from your morning cup of coffee to last all day instead of just a few hours. On the downside, it’s easy to overdo it and end up wide-eyed in bed when you are trying to go to sleep.

Considering this information, again, it is best to be mindful and cautious when mixing caffeine and CBD.

Can CBD Oil Be Addictive?

One of the most common questions we get is: Can I get addicted to CBD oil? The answer depends on what you mean by “addicted.”

When looking at the chemical impacts of CBD oil, the answer is no. Cannabidiol is not physically addictive in the same way opiates, cocaine, alcohol, and other drugs can be. Also, CBD oil does not produce any physical withdrawal symptoms when you stop using it. In fact, CBD oil is currently being researched as a potential tool for minimizing the severe withdrawal from drugs like opiates.

But, having said that, human beings can get addicted to just about anything including exercise, music, sex, and food.

Because CBD oil can alter essential liver enzymes, it is crucial to do your research, talk to your physician, and figure out how to best consume CBD oil for your specific situation.

Information and education will be your most powerful weapons going forward.

How To Use CBD Oil

When taking cannabidiol, it is important to consume only the recommended serving size.  

Raising or lowering this amount may produce the opposite of the desired effect.

Keep in mind that some people may metabolize cannabidiol differently because of anomalies within the cytochrome P45O (CYP450) enzyme system. And depending on when you take your medications, you may find an unintended increase or decrease in CBD concentrations in your blood.

If you suspect that you are not metabolizing CBD oil as expected, ask your doctor to test your cytochrome P450 enzyme system before adjusting your dosage.

Also, you may refer to our page on dosing CBD oil for additional information.

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208 responses to “Drugs that May Interact with CBD Oil”

  1. Avatar Julie says:

    Absolutely yes! By me husbands dr. He has lupus and takes his plaquenil every day and is on 750mg 5 drops ea AM and 5 drops ea PM

  2. Avatar Julie says:

    My husband has lupus so thankfully we are after a year coming off prednisone. Yes you can take it but here’s the deal .. take your meds and cbd 2 hrs apart. Whichever you take first is fine just separate the meds from the cbd and it gives everything taken a correct path to get to work. Hope you won’t be on prednisone too long. The withdrawals put my husband in the bed for 3 days… flu like symptoms and a fever. Cbd really got him through

  3. Avatar Julie says:

    I chew nicotine gum and take cbd. Cbd should be taken and always wait 20 minutes to do what’s next whether that’s drink, eat vape.

  4. Avatar Julie says:

    I use it in combo. I talked with my psychiatrist about it. I go through periods of insomnia. When that happens you can take them both at night. I personally take all my meds and supplements at 830pm and my cbd right at bedtime at 11pm.

  5. Avatar Julie says:

    Cbd oil when first starting is known to “detox” Most people get a slight headache. But the detox is over in 24 hrs. There are no side effects really to cbd

  6. Avatar Julie says:

    I could write a novel. Lol Just Google endocannibinoid system. It’ll talk about receptors and how CBD works with them. I’m glad when doctors are on board

  7. Avatar Julie says:

    I work with cbd oil users going to pain management. You MUST take THC FREE cbd or it will show up

  8. Avatar Julie says:

    Good for you! My husband has lupus and is finally getting off steroids. He was on them over a year. Cbd got him thru 3 days in bed … flu symptoms. Just awful. Don’t let them keep you on steroids too long. Cbd oil takes his pain away and he isn’t going on the anti transplant rejection freakin medication they want to put him on next. No more meds he says. Just CBD. And we take Hempworx

  9. Avatar Julie says:

    Depends on where you got it and what’s in it There’s a US Hemp seal of Approval list on cbd oil Only buy from that list. They are third party tested. There should be only 2 ingredients… hemp seed carrier oil and CBD. So many companies say Pure when it’s junk.

  10. Avatar Julie says:

    upping your dosage so quickly made you have diarrhea. You’ve got to go really slow to find the amount of drops that a right for you. And yes cbd is a natural blood thinner. Tell your doc you’re on it. My hubby has lupus. His rheumatologist told him to not take it bc it wasn’t fda approved. He told her I’m in no pain and feel more alive than I have in the last 5 months I’ve been taking it. So I’m not asking you I’m telling you so you can put it in your chart.

  11. Avatar Julie says:

    Tylenol is just terrible to take on a consistent basis. Would be good to have her off that and on a really good 1500mg cbd. Cbd is a natural pain killer. And you read that right. My dogs pet cbd is 250mg. I take 750mg myself. With her pain level she would do well off Tylenol codeine and on 1500mg cbd. No side effects. No drowsiness. Sleepiness. That’s what I’d do if she were my mom. 1500mg is what my cousin uses for his chronic arthritis. He doesn’t take any pain pills and hasn’t in 6 yrs on cbd.

  12. Avatar Julie says:

    Yes absolutely. It will help with any withdrawals. Sometimes coming off an anti anxiety med can cause you anxiety if that makes since. At least it did with me so I took my cbd at the same time. My husband finally came off prednisone for his lupus after being on it for 2 years. 3 days in bed withdrawing and cbd and Motrin to reduce the fever is what got him through. It was awful!

  13. Avatar Julie says:

    I’m not sure you should have started out on a high dosage 3000mg. Good Lord. My husband has lupus and is on 750mg 5 drops am and 5 drops pm. for his pain! Perhaps you should choose a brand that has the US Hemp seal of approval. That way you’ll know what’s in that bottle bc it’s third party tested Its important to know what’s in the bottle. Should only be 2 ingredients… hemp seed oil and carrier oil and cbd. That’s it. Seriously you’re taking way too high a dosage. And I was on provigal. Very helpful for staying awake for sleep apnea patience and chronic fatigue. I took it at 20mg a day to get me out of bed for severe depressive episode.

  14. Avatar Julie says:

    Yes for me personally I use cbd and my psychiatrist says it’s fine. He said many patients are on it too. It’s a supplement and should be taken an hour before or after meds.What I personally do is take my lexapro,Ativan,lamictal and topimax at 830pm every night. I usually dose 5 drops right at bedtime at 11pm.

  15. Avatar Dan Eidt says:

    Sounds like an allergic reaction.

  16. Avatar john says:

    Doctors make a hell of a lot more off of eliquis than CBD oil.

  17. Avatar Karin Murphy says:

    Please, stay away from Ambien. It is a devil drug and should be taken off the market. I am also under much pain and take Norco 10mg every 4-6 hours. Will speak to my doctor about CBD oil. Any relief is most welcome.

  18. Avatar Shelby says:

    I too am on Norco’s (10 mg) for degenerative disc disease, arthritis in both hips and lower spine. I recently started on CBD oil and would love to come off the Norco’s completely.

    I will of course speak to my doctor about this, but he is the one that actually pointed me to the CBD initially.

    Any help or recommendations is greatly appreciated.

  19. Avatar Colleen Simmons says:

    I have severe depression, anxiety, PTSD. I’ve been on the listed medications for 10 years plus. I am currently taking Klonopin, ambien, celexa, lamictal, saphris, wellbutrin and inderal. The medication just doesn’t seem to be adequate anymore. Can CBD be compatible with the above stated medicines. Can they help to get me off of some of the med’s. Thank you for your time.

  20. Avatar MyCBDLife says:

    I use Xanax and CBD with no problems. I am using CBD to treat intense pain while I am still going through testing for a variety of autoimmune diseases.
    I smoke it. My dose is regulated in a pattern and it has allowed me to find a happy medium for myself. I smoke about 1-1.5 grams of CBD flow a day. The strain I use is the one that is right for me.

  21. Avatar Veena Rellan says:

    I take Tylenol, Mobic Cymbalta Flecanide Myrabetric Librax Estradiol!

  22. Avatar Sherri Hertzog says:

    I am on Synthroid,and my Dr recommended CBD oil,to help with mild anxiety.Ask your Dr.?

  23. Avatar Jen says:

    How are you feeling since taking CBD oil with the Zoloft? I have been on 50 mg of Zoloft for almost 3 years & planning to start adding in CBD oil. Feeling a little nervous though, but my doctor prescribed it.

  24. Avatar Eve says:

    Can you take CDP oil while taking 70 mg Oxicontin daily Asprin,6 Tradol plus 37.5mg,Arcoxia 90mg,Trental 400mg,Atorvas 40mg Lamicsl 50mg Thanks in advance

  25. Avatar Amy Anderson says:

    Very interesting and informative article pal!

  26. Avatar Tina Remy says:

    I take losartan and I take CBD oil no problems so yes it should be okay to take with Losartan

  27. Avatar Tina Remy says:

    That’s not true I take high cholesterol medicine and I take CBD oil no inner actions at all no issues whatsoever so go ahead it is safe to take CBD oil with cholesterol medicine

  28. Avatar Tina Remy says:

    It will not interfere with blood pressure medicine it will not interfere with metformin I take blood pressure medicine and I take metformin and I also take my CBD oil no problems the other medicines I am not sure I would Google it but when the metformin and the blood pressure medicine I take blood pressure medicine and Metformin and I have had absolutely no issues at all

  29. Avatar Tina Remy says:

    It should not interfere Google your question

  30. Avatar Tina Remy says:

    I wouldn’t you should stop vaping it is very very dangerous

  31. Avatar Tina Remy says:

    Make sure when you take CBD oil it is 100% pure CBD oil make sure it has no THC in it that’s why your skin was feeling the way it was 100% pure CBD oil I am a type 2 diabetic I am trying to wean myself off of my diabetes medicine so I can reverse my diabetes so please 100% pure CBD oil no THC

  32. Avatar Tawny says:

    Make sure there’s 3 Rd party lab results and it’s a good reputable company. Start slow and work ur way up .look up microdosing for CBD and it will help you to find ur sweet spot. If u take to much it’s not doin anything for you less is more with cbd. I started with a 3000 mg bottle and take 8 drops only drops and it works great it’s only like 12 mg of CBD .always separate ur medication and CBD by two hours. Best of luck

  33. Avatar BARBARA says:

    Hi I took gabapentin, up to 600 mg per day, it didn’t to much for my pain hence the canibis oil.

  34. Avatar BARBARA says:

    I take 3 different BP meds, also metformin & mint glizacide for type 2 diabetes. I started taking cannabis oil about 1 month ago. I’m taking this for my sciatic, arthritis, & neuropathy pain. My doctor says it is ok to take up to x3 per day. I also take clonazepam for anxiety & to aid w/sleep @ night. I’M not ready to just take canibis, & not take the anxiety pill. I have had trouble falling off to sleep naturally for about 15 years. I need my sleep as I work early mornings. P/T.

  35. Avatar Debra says:

    I’ve used CBD oil, THC free, for a few years now with no side effects what so ever. I have had 4 spinal surgeries with the last being a spinal cord stimulator for pain. I also have Fibromyalgia, Rheumatoid Arthritis, plus a few other assorted ailments. I’ve suffered from severe chronic pain for several years now and am on many prescriptions, including oxycodone, which I have been able to keep at a low dosage with the help of CBD oil. It has also helped with my depression at times. I would definately speak with yur specialist prior to beginning on the therapy and use a reputable companyto get your CBD oil from where you can check their testing product location.

  36. Avatar Kim says:

    Hi I recently started taking 400mg of Vimpat daily and want to know how does cbd oil interact with Vimpat

  37. Avatar Tara M says:

    Hi. Is it safe to take CBD oil while taking Humira!! I appreciate any help. 🙂

  38. Avatar Heidi A Robinson says:

    I would check with both a pharmacist and your Physician. Several of your medications are in direct conflict with another; essentially cancelling out the effect both medications beneficial effects.
    I am not a Dr, just a Senior Citizen who also has multiple physical maladies. I have been through the Gamut of medications. Via many long years of trial/error of physicians basically “experimenting” to see what did and/or did not work.
    After experiencing many Severe adverse side effects,
    Or no effect at all due to the Dr prescribing medications that cancelled each other out.
    Hopefully both you and myself, the CBD Oil will have the proper effect for Pain Management, Epilepsy Management, and PTSD.
    All I know at this time is that the CBD Oil needs adjusted for enough effect to accomplish the desired effects of both My Physician and Myself.

  39. Avatar Nod says:

    If you stopped drinking fluoride, you might not need those thyroid drugs.

    “According to the U.S. National Research Council, and as discussed below, there is substantial evidence that fluoride exposure can impact thyroid function in some individuals. (NRC 2006).

    Fluoride Was Once Prescribed as an Anti-Thyroid Drug
    When people think of fluoride being prescribed for medicinal purposes, they generally think of fluoride supplementation to reduce tooth decay. Fluoride, however, has also been prescribed as a drug to reduce the activity of the thyroid gland. Up through the 1950s, doctors in Europe and South America prescribed fluoride to reduce thyroid function in patients with over-active thyroids (hyperthyroidism). (Merck Index 1968). Doctors selected fluoride as a thyroid suppressant based on findings linking fluoride to goitre, and, as predicted, fluoride therapy did reduce thyroid activity in the treated patients. (McClaren 1969; Galletti 1958; May 1937). Moreover, according to clinical research, the fluoride dose capable of reducing thyroid function was notably low — just 2 to 5 mg per day over several months. (Galletti & Joyet 1958). This dose is well within the range (1.6 to 6.6 mg/day) of what individuals living in fluoridated communities are now estimated to receive on a regular basis. (DHHS 1991).

    Fluoride & Hypothyroidism
    Based on fluoride’s anti-thyroid effects in hyperthyroid patients, concerns have arisen about whether current fluoride exposures could be contributing to the increased prevalence of under-active thyroid (clinical and/or subclinical hypothyroidism) in the United States and other nations. In February 2015, British scientists reported that fluoridated water in Britain is associated with elevated rates of hypothyroidism:”

  40. The Editor The Editor says:

    Unfortunately, not every doctor will be educated on CBD. One thing you can do is find a cannabis doctor online to schedule a consultation over the phone. Mind you, they will charge you a fee and most likely will not take insurance. They are licensed and will be able to answer most, if not all, of your questions.

  41. Avatar june huguley says:

    Take your blood pressure. I take lisinopril 10mg and my blood pressure dropped real low 96 over 55 and it made me lightheaded. I stopped the cbd oil until my pressure goes back up.

  42. Avatar june huguley says:

    What if your doctor is so dumb about hemp cbd oil that he is not able to answer your questions. Then what can you do? I take blood pressure medicine and my blood pressure dropped real low and I stopped the cbd oil. The oil helped my pain and help me sleep.

  43. Avatar Antonette says:

    I just started taking CBD oil. I DO take Lisinopril and have for over a year. I am experiencing extreme lightheadedness and nausea. I reduced the amount of CBD this morning to only 3 drops of 1000 mg strength. Within minutes I was having a negative reaction. I had to lay down for 4 hours as it made me dizzy and nauseated.

  44. Avatar Greg says:

    Ambien is not a nice drug. You can be somnambulant while on it. Some people drive a car, make a meal, or do other things, during the night, and have no idea (the next morning) that they did then.

  45. Avatar Greg says:

    That’s directed toward the OP. Argelia.

  46. Avatar Greg says:

    Holy moly, that’s a lot of drugs.

    Temazepam should only be used for about one week, for example.

    Too many drugs being prescribed for them!

  47. The Editor The Editor says:

    Please always check with your prescribing doctor for any medical advice.

  48. The Editor The Editor says:

    Please always check with your prescribing doctor for any medical advice.

  49. The Editor The Editor says:

    Please check with your physician for medical advice.

  50. The Editor The Editor says:

    Please check with your physician for medical advice.

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